Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009819 | NY |
NPI | 1215577507 |
---|---|
Provider Name | Ms. Denise R Jones |
First Address | Ridgewood, NY 11385-2644 |
Second Address | Ridgewood, NY 11385-2644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2020 |
Last Update Date | 11/03/2020 |